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R13801CP: NCD 20.38 - Transcatheter Edge-to-Edge Repair for Tricuspid Valve Regurgitation (T-TEER)
Effective date
Jul 2, 2025
Identified
Jun 16, 2026
Summary
Medicare covers transcatheter edge-to-edge repair for tricuspid valve regurgitation (T-TEER) for symptomatic tricuspid regurgitation under Coverage with Evidence Development, according to NCD 20.38, effective July 2, 2025. Institutional and professional claims must carry the ICD-10-PCS, HCPCS, ICD-10-CM and modifier data listed in the notice, including the 8-digit National Clinical Trial number. Claims that do not meet these criteria are returned to provider, returned as unprocessable, or denied using the messages listed in the notice.
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What to do
Action · 6 steps
01Already effective July 2, 2025 (implementation January 5, 2026): For institutional T-TEER claims with ICD-10-PCS 02UJ3JZ, bill Type of Bill 11X, report ICD-10-CM Z00.6 as the other diagnosis, report condition code 30, and report value code D4 with the 8-digit National Clinical Trial number.
02Inpatient hospitals bill T-TEER on 11X.
03The principal ICD-10-CM diagnosis must be one of I07.1, I07.2, I08.1, I08.2, I08.3, I36.1, I36.2 or Q22.8.
04For Medicare Advantage enrollees, hospitals also report condition code 04.
05For professional claims for HCPCS 0569T or 0570T in a clinical research study, include Z00.6 as the other diagnosis, the 8-digit clinical trial number, one of the principal diagnoses listed above, and modifier Q0.
06Line items billed without modifier Q0 or without the clinical trial number are returned as unprocessable.
Codes mentioned
I07.1I07.2I08.1I08.2I08.3I36.1I36.2Q22.8Z00.6
Original notice
R13801CP: NCD 20.38 - Transcatheter Edge-to-Edge Repair for Tricuspid Valve Regurgitation (T-TEER)
cms.gov · Always check the source before changing claims.
Related changes
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